Background: The provision of obstetric and newborn care is often considered a basic service in a community hospital.  In rural communities with low birth volumes, multiple challenges exist for the delivery of a quality health care obstetric and newborn service.  Acquiring and maintaining sufficient, skilled specialty resources for the delivery of high risk low volume obstetric care presents the opportunity for risk to safety and the potential for negative clinical and quality outcomes.  Financial implications must also be considered in the evaluation of maintaining an obstetric/newborn service in a rural community hospital. 

Case: The decrease in the population of child bearing age women in the region, reduced number of births, increased costs associated with minimum staffing of multiple interdisciplinary resources for the provision of the obstetric service, and the losses related to increased Medicaid covered patients justified the need for a thorough assessment and evaluation of the inpatient obstetric/newborn service and the subsequent decision for service closure.  Planning and implementation for the closure of the inpatient obstetric/newborn service in a rural community hospital presented multiple opportunities and challenges for the nursing leadership team.  The communication plan regarding service closure and education regarding the plan for care for obstetric patients after service closure was identified for the community, health care providers, and current obstetric patients receiving care.  Triage assessment, birth, and emergency care procedures for obstetric related health care issues were identified with education completed for nursing and interdisciplinary Emergency Department team members to ensure competency and standard of care delivery for the obstetric and newborn patient population.  A coordinated plan for obstetric care was identified with the rural community and birth facility nursing and physician team members to assure access to prenatal care close to home early in pregnancy and the successful transition of the obstetric patient and her health information to the birth physician and birth facility in the third trimester.

Conclusion:   The closure of the obstetric/newborn unit was an emotional issue for the community with the originally defined plans for post-closure obstetric care requiring multiple revisions to achieve the desired provision of obstetric care for prenatal care access, appropriate emergency care for obstetric issues at the rural community hospital, and transition of patients to the provider and facility for labor and birth.  Nurses have a key role as advocates for obstetric patients navigating care across a multi-faceted continuum for service. 

Keywords: Obstetrics Program Closure, Prenatal Care, Care Transition